Prevalence of Delirium with Dexmedetomidine Compared with Morphine Based Therapy after Cardiac Surgery

Background: Commonly used sedatives/analgesics canincrease the risk of postoperative complications, including delirium.This double-blinded study assessed the neurobehavioral,hemodynamic, and sedative characteristics of dexmedetomidine compared with morphine-based regimen after cardiac surgery at equivalent levels of sedation and analgesia.

Methods: A total of 306 patients at least 60 yr old were randomized to receive dexmedetomidine (0.1– 0.7
g · kg1 ·h1) or morphine (10-70
g · kg1 · h1) with open-label propofol

titrated to a target Motor Activity Assessment Scale of 2–4.

Primary outcome was the prevalence of delirium measured daily via Confusion Assessment Method for intensive care. Secondary outcomes included ventilation time, additional sedation/analgesia, and hemodynamic and adverse effects.

Results: Of all sedation assessments, 75.2% of dexmedetomidine and 79.6% (P  0.516) of morphine treatment were in the target range. Delirium incidence was comparable between dexmedetomidine 13 (8.6%) and morphine 22 (15.0%) (relative risk 0.571, 95% confidence interval [CI] 0.256–1.099, P  0.088),however, dexmedetomidine-managed patients spent 3 fewer days (2 [1–7] versus 5 [2–12]) in delirium (95% CI 1.09–6.67, P 0.0317). The incidence of delirium was significantly less in a small subgroup requiring intraaortic balloon pump and treated with dexmedetomidine (3 of 20 [15%] versus 9 of 25 [36%])(relative risk 0.416, 95% CI 0.152–0.637, P  0.001). DexmedetoDexmedetomidine-

treated patients were more likely to be extubated earlier (relative risk 1.27, 95% CI 1.01–1.60, P  0.040, log-rank P  0.036), experienced less systolic hypotension (23% versus

38.1%, P  0.006), required less norepinephrine (P < 0.001),but had more bradycardia (16.45% versus 6.12%, P  0.006)than morphine treatment.Conclusion: Dexmedetomidine reduced the duration but notthe incidence of delirium after cardiac surgery with effective analgesia/sedation, less hypotension, less vasopressor requirement,and more bradycardia versus morphine regimen.
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